Suchergebnisse

RESUMO Na República da Guiné-Bissau, um dos países mais pobres do mundo, o Plano Nacional de Desenvolvimento Sanitário (PNDS) pretende ser o documento de orientação nacional em saúde. O PNDS II (2008-2017) sucedeu ao PNDS I (1998-2002, revisto para 2003-2007). Ambos foram alvo de avaliações. Em 2017, completou-se um novo processo de planejamento, o PNDS III. Considerando o PNDS, procedeu-se a uma meta-avaliação objetivando avaliar a qualidade das avaliações efetuadas e verificar a utilização dos resultados das avaliações em intervenções subsequentes. Aplicados padrões de meta-avaliação aos relatórios de avaliação, verificou-se que, relativamente aos quatro princípios de meta-avaliação – utilidade, exequibilidade ou factibilidade, propriedade e precisão ou acurácia –, ambas as avaliações apresentam a classificação de 'satisfatório' (score superior a 66,6%), revelando um caráter de excelência para vários padrões. Metodologicamente, o relatório referente ao PNDS I sobressai sobre o do PNDS II. Na fase de planejamento, as sugestões deixadas pela avaliação anterior foram levadas em conta tanto para o PNDS II como para o III. A fragilidade do Estado da Guiné-Bissau emerge como padrão de especificidade. O PNDS tem sido uma referência em cenários de instabilidade. Tais avaliações foram ao encontro do atual desafio de considerar o contexto, e, nele, a cultura dos povos, como parte integrante da avaliação.

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Corrected for purchasing power parity, the government pays the respondents a median salary of 3,800 US$PPP per annum. This salary puts these managers among the better-off in their countries. However, it definitely remains below what they could expect from alternative occupations as medical doctors in their own countries. An impressive 87% of the respondents complement their salaries with at least one of the following: working for NGOs or development agencies, private practice, or other income-generating activities. All in all moonlighting adds an extra 50 to 80% to their public sector salaries. There are three possible consequences: competition for time, outflow of resources from the public sector, and conflicts of interest. The problem of moonlighting needs to be addressed openly so as to protect public sector values while meeting both professional needs and user demands for quality.

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Corrected for purchasing power parity, the government pays the respondents a median salary of 3,800 US$PPP per annum. This salary puts these managers among the better-off in their countries. However, it definitely remains below what they could expect from alternative occupations as medical doctors in their own countries. An impressive 87% of the respondents complement their salaries with at least one of the following: working for NGOs or development agencies, private practice, or other income-generating activities. All in all moonlighting adds an extra 50 to 80% to their public sector salaries. There are three possible consequences: competition for time, outflow of resources from the public sector, and conflicts of interest. The problem of moonlighting needs to be addressed openly so as to protect public sector values while meeting both professional needs and user demands for quality.

BACKGROUND: Angola is among one of the most deprived countries in the world in terms of medical professionals. In the past decade, the Angolan Government has invested in the expansion of faculties of medicine in the country. We analysed the profiles of medical students in Angola according to four clusters of medical schools: older faculty in the country, private faculties, Cuban sponsored faculties and military faculty; under the assumption that the organizational culture of the different faculties might influence the expectations and decisions towards future professional life of medical students regarding where they want to work (community versus hospital) and in which sector (exclusively public versus not exclusively public). METHODS: Observational cross-sectional study. Piloted, standardized questionnaire to final year medical students or higher year of training in the first four-month of 2014 (N = 402). Data were entered into a SPSS v.20 database and descriptive statistics computed. Statistical significance for categorical variables was tested by Pearson chi-square, Fisher exact or likelihood ratio tests as appropriate. Comparison of means was tested with Anova. Backward elimination binary logistic regression was used to test the hypothesis that type of faculty of medicine is an important determinant of future professional practice, i.e., level (hospital vs. community) or sector of practice (exclusive public sector vs. private or private and public), while controlling for confounders. RESULTS: After controlling for age, sex, marital status, place of birth and place of primary and secondary education, type of family and family influence, students were more likely to choose community over hospital practice and to prefer exclusive public practice if attending a Cuba supported faculty of medicine. CONCLUSIONS: Medical education cannot be isolated from planning of the medical workforce. Some important and impactful careers choices, like choosing rural over urban practice, public over private sector practice, have ...

Funding Information: Rosa Ferrinho for assistance with data processing and literature search. COSEP for data collection. Funda??o para a Ci?ncia e Tecnologia for funds to GHTM UID/04413/2020. This study was part of a broader consultation for the Government of Angola. Authorization for publishing this study was obtained from the Ministry of Health of Angola. Funding Information: The study was sponsored by the Government of Angola. Publisher Copyright: © 2021, The Author(s). ; Background: Angola is among one of the most deprived countries in the world in terms of medical professionals. In the past decade, the Angolan Government has invested in the expansion of faculties of medicine in the country. We analysed the profiles of medical students in Angola according to four clusters of medical schools: older faculty in the country, private faculties, Cuban sponsored faculties and military faculty; under the assumption that the organizational culture of the different faculties might influence the expectations and decisions towards future professional life of medical students regarding where they want to work (community versus hospital) and in which sector (exclusively public versus not exclusively public). Methods: Observational cross-sectional study. Piloted, standardized questionnaire to final year medical students or higher year of training in the first four-month of 2014 (N = 402). Data were entered into a SPSS v.20 database and descriptive statistics computed. Statistical significance for categorical variables was tested by Pearson chi-square, Fisher exact or likelihood ratio tests as appropriate. Comparison of means was tested with Anova. Backward elimination binary logistic regression was used to test the hypothesis that type of faculty of medicine is an important determinant of future professional practice, i.e., level (hospital vs. community) or sector of practice (exclusive public sector vs. private or private and public), while controlling for confounders. Results: After controlling for age, sex, marital status, place of birth and place of primary and secondary education, type of family and family influence, students were more likely to choose community over hospital practice and to prefer exclusive public practice if attending a Cuba supported faculty of medicine. Conclusions: Medical education cannot be isolated from planning of the medical workforce. Some important and impactful careers choices, like choosing rural over urban practice, public over private sector practice, have deep influences in the medical professionals' labour market. Some of these decisions are shaped even before the end of the medical training. As such, the monitoring of future professional intentions in medical schools should be done regularly to accommodate both the health system needs and the hopes and dreams of medical trainees. ; publishersversion ; published

Health sector workers respond to inadequate salaries and working conditions by developing various individual "coping strategies"--some, but not all, of which are of a predatory nature. The paper reviews what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest). By and large, governments have rarely been proactive in dealing with such problems, mainly because of their reluctance to address the issue openly. The effectiveness of many of these piecemeal reactions, particularly attempts to prohibit personnel from developing individual coping strategies, has been disappointing. The paper argues that a more proactive approach is required. Governments will need to recognize the dimension of the phenomenon and systematically assess the consequences of policy initiatives on the situation and behaviour of the individuals that make up their workforce.

INTRODUCTION Current health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper we describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care. POPULATION AND METHODS We used secondary data from the "March 2008 payroll data base", which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. We computed rates and ratios and compared them. RESULTS The highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers).The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces.This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763.In the whole country, the data set showed only 109 staff in health posts: 1 clinical officer, 3 environmental health technologists, 2 registered nurses, 12 enrolled midwives, 32 enrolled nurses, and 59 other.The vacancy rates for level 3 facilities(central hospitals, national level) varied from 5% in Lusaka to 38% in Copperbelt Province; for level 2 facilities (provincial level hospitals), from 30% for Western to 70% for Copperbelt Province; for level 1 facilities (district level hospitals), from 54% for the Southern to 80% for the Western provinces; for rural health centres, vacancies varied from 15% to 63% (for Lusaka and Luapula provinces respectively); for urban health centres the observed vacancy rates varied from 13% for the Lusaka to 96% for the Western provinces. We observed significant shortages in most staff categories, except for support staff, which had a significant surplus. DISCUSSION AND CONCLUSIONS This case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity. ; publishersversion ; published

Résumé Cet article passe en revue soixante années de réformes du système de santé portugais. Les principales réformes ont été engagées après la Révolution de 1974. Jusqu'à la fin des années quatre-vingt, le Service national de santé est resté très centralisé. Puis, à partir des années quatre-vingt-dix, un certain nombre de mesures témoignent de l'intérêt porté à la décentralisation : instauration des autorités sanitaires régionales, création de marchés internes de la santé et d'agences de contractualisation, séparation entre les fonctions d'acheteur et d'offreur, tentatives d'introduction de méthodes de gestion issues du monde de l'entreprise, mise en place de services de proximité, intégration verticale (locale) et création de réseaux régionaux d'établissements. Dans le cadre de ce processus de décentralisation, la politique de santé a continué de relever de l'État – y compris sur le plan fiscal et financier –, tandis que la fourniture des soins a été de plus en plus décentralisée. Cette décentralisation de l'offre de soins a obéi essentiellement à deux logiques : la dévolution et la déconcentration. Des tentatives de privatisation ont également eu lieu, mais ont entraîné une recentralisation. Au Portugal, la recherche d'un modèle de décentralisation s'est donc traduite par une redéfinition continuelle de la place qu'occupent respectivement les niveaux central et sub-national dans le processus décisionnel. Il est peu vraisemblable que l'on assiste à un ample mouvement de décentralisation au Portugal dans un avenir proche.